P93 vs P96.1
P93 and P96.1 can never be reported together. ICD-10-CM declares them mutually exclusive with an Excludes1 note, meaning the two conditions cannot occur in the same patient — so exactly one of them is correct for any given encounter. The distinction is perinatal vs later onset.
The official note, declared on P93
withdrawal symptoms from maternal use of drugs of addiction (P96.1)
P93
Reactions and intoxications due to drugs administered to newborn
Not billable
- Chapter 16
- Certain conditions originating in the perinatal period
- Section
- P90-P96
Use when the record says
- reactions and intoxications due to drugs administered to fetus affecting newborn
P96.1
Neonatal withdrawal symptoms from maternal use of drugs of addiction
Billable
- Chapter 16
- Certain conditions originating in the perinatal period
- Section
- P90-P96
Use when the record says
- Drug withdrawal syndrome in infant of dependent mother
- Neonatal abstinence syndrome
Indexed under
- Abstinence symptoms, syndrome › neonatal
- Newborn › abstinence syndrome (infant) (liveborn) (singleton)
- Syndrome › abstinence, neonatal
- Syndrome › drug withdrawal, infant of dependent mother
- Syndrome › neonatal abstinence
Excludes1 is not always absolute: where two conditions covered by the note are genuinely unrelated, CMS guidance permits reporting both. Document the reasoning rather than assuming it. More on Excludes1 vs Excludes2 · FY2027